Sunday, January 16, 2011

This morning I presented a shiur on halachic issues in treating anxiety and depression.

I've used other opportunities to talk about clinical depression, such as in the Rosh haShanah derashah you can find here. This was a halachah shiur, though, part of a monthly CME shiur given to physicians. The focus was on whether these mental health conditions qualify to warrant violation of Shabbat, kashrut, and the laws of contraception and abortion.

You can find the audio and source sheet here; below are the vignettes we used:

Joshua, a 45 year old man, experiences racing thoughts and mania, for which he has begun a course of antipsychotics. Is he permitted to take them on Shabbat?

Leah, a 25 year old mother of two children, experienced heavy postpartum depression after both births, managing it only with extensive therapy and drug treatment. She would like to begin birth control to avert future pregnancies. Birth control pills, generally considered the halachically best form, might lead to worse symptoms; she would want to use an IUD. May she use an IUD?

Jason, 38, displays symptoms of depression, and has spoken, albeit vaguely, of suicidal thoughts. It is Friday, and the only option for commitment is a facility where kosher food is unavailable, and he will need to remain in a non-shomer-shabbat environment through Shabbat. May we commit Jason?

Lauren, 50, is manifesting signs of serious depression, including loss of appetite, lack of care for her person, and loss of a feeling of self-worth. However, she refuses treatment. May we treat Lauren against her will?

Julia, 17, has attempted suicide with overdoses of medicine before. We would like to treat with SSRIs in order to lower risk of overdose, but we know that some studies have shown increased suicidal ideation in young patients, while others have not. May we treat with SSRI’s?